1
|
Dueñas-Rodríguez B, Navarro-Cecilia J, Luque-López C, Sánchez-Andujar B, Garcelán-Trigo JA, Ramírez-Expósito MJ, Martínez-Martos JM. Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes. Cancers (Basel) 2023; 15:5349. [PMID: 38001609 PMCID: PMC10670310 DOI: 10.3390/cancers15225349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
We evaluate postoperative complications, aesthetic results and satisfaction outcomes in patients with breast cancer after intervening with a skin-sparing or nipple-sparing mastectomy with an immediate prosthetic reconstruction with or without a biological mesh. Patients with multifocal breast cancer, ductal carcinoma in situ with an indication for a mastectomy and cT2 tumors with no response to primary systemic treatment were included, whereas patients aged >75 years, with inflammatory carcinoma, and severe circulatory disorders were excluded. Patients in the control group were reconstructed using a prosthesis, whereas the study group included patients reconstructed using a prosthesis and biological acellular porcine dermal mesh (Strattice™). In both groups, the result was assessed using the BREAST-Q instrument. A total of 51 patients (62 intervened breasts) were included in the study group and 38 patients (41 intervened breasts) in the control group. Implant loss and removal occurred in three patients in the study group (5.9%) and nine patients in the control group (24.3%; p = 0.030). Infections appeared in three patients in the study group (4.8%) and three patients in the control group (7.3%; p = 1.00). Skin necrosis appeared in 5 patients in the study group (12.2%) and 11 patients in the control group (21.6%; p = 0.367). Seroma appeared in five patients in the study group (12.2%) and five patients in the control group (8.1%; p = 0.514). The BREAST-Q questionnaire is a comparison between both groups regarding "satisfaction with breasts after surgery" (p = 0.026), "sexual well-being after intervention" (p = 0.010) and "satisfaction with the information received" (p = 0.049). We have noted a statistically significant decrease in implant loss in women receiving an implant with a biological mesh. A higher satisfaction was observed in patients reconstructed using Strattice™, with statistically significant differences in three items.
Collapse
Affiliation(s)
- Basilio Dueñas-Rodríguez
- Unit of Breast Pathology, Department of Surgery, Hospital Complex of Jaén, 23007 Jaén, Spain; (B.D.-R.); (J.N.-C.); (B.S.-A.)
| | - Joaquín Navarro-Cecilia
- Unit of Breast Pathology, Department of Surgery, Hospital Complex of Jaén, 23007 Jaén, Spain; (B.D.-R.); (J.N.-C.); (B.S.-A.)
| | - Carolina Luque-López
- Department of Gynecology and Obstetrics, Hospital Complex of Jaén, 23007 Jaén, Spain;
| | - Belén Sánchez-Andujar
- Unit of Breast Pathology, Department of Surgery, Hospital Complex of Jaén, 23007 Jaén, Spain; (B.D.-R.); (J.N.-C.); (B.S.-A.)
| | | | - María Jesús Ramírez-Expósito
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, School of Experimental and Health Sciences, University of Jaén, 23071 Jaén, Spain;
| | - José Manuel Martínez-Martos
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, School of Experimental and Health Sciences, University of Jaén, 23071 Jaén, Spain;
| |
Collapse
|
2
|
Bassetto F, Pandis L, Facchin F, Azzena G, Vindigni V. Braxon®-assisted prepectoral breast reconstruction: A decade later. Front Surg 2022; 9:1009356. [PMID: 36420412 PMCID: PMC9677958 DOI: 10.3389/fsurg.2022.1009356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
We are sitting on the cusp of the bioengineered breast era, in which implant-based breast reconstruction is seeing a growing trend and biotechnology research progressively empowers clinical practice. As never before, the choice of biomaterials has acquired great importance for achieving reconstructive outcomes, and the increase in the use of acellular dermal matrices (ADMs) in the field of senology tells us a story of profound upheaval and progress. With the advent of prepectoral breast reconstruction (PPBR), plenty of devices have been proposed to wrap the silicone prosthesis, either completely or partially. However, this has caused a great deal of confusion and dissent with regard to the adoption of feasible reconstructive strategies as well as the original scientific rationale underlying the prepectoral approach. Braxon® is the very first device that made prepectoral implant positioning possible, wrapping around the prosthesis and exerting the proven ADM regenerative potential at the implant–tissue interface, taking advantage of the body's physiological healing mechanisms. To date, the Braxon® method is among the most studied and practiced worldwide, and more than 50 publications confirm the superior performance of the device in the most varied clinical scenarios. However, a comprehensive record of the working of this pioneering device is still missing. Therefore, our aim with this review is to lay a structured knowledge of surgery with BRAXON® and to provide a decision-making tool in the field of PPBR through a complete understanding on the very first device for prepectoral, one decade after its introduction.
Collapse
|
3
|
Evaluation of Xenograft Efficacy in Immediate Prosthesis-based Breast Reconstruction. Plast Reconstr Surg Glob Open 2022; 10:e4534. [PMID: 36187275 PMCID: PMC9521749 DOI: 10.1097/gox.0000000000004534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022]
Abstract
The advent of acellular dermal matrix (ADM) has revolutionized prosthesis-based breast reconstruction. However, paucity of human cadaveric tissue has resulted in limitation of supply and increased associated costs, prompting concerted effort to identify xenograft alternatives. Although studies have examined the safety of Artia, a porcine-derived ADM, few have evaluated its clinical efficacy as soft tissue reinforcement. This study uniquely evaluates the clinical efficacy of Artia in implant-based breast reconstruction.
Collapse
|
4
|
Pouzet L, Hotton J, François C, Wehbe K, Dabiri C, Ceccato V. Breast reconstruction with silicone prosthesis and acellular dermal matrix of porcine origin: Retrospective study of 84 cases. ANN CHIR PLAST ESTH 2022; 67:133-139. [PMID: 35680492 DOI: 10.1016/j.anplas.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Breast reconstruction (BR) using a prosthesis implant (PI) associated with an acellular dermal matrix (ADM) is a known method that has been the subject of discussion in recent years. The objective of this study was to quantify the rate of PI removal after BR using prosthesis combined with ADM, and to identify the risk factors in the event of removal. METHODS This was a retrospective study conducted between 2010 and 2015. Inclusion criteria were patients who had undergone immediate (IBR) or delayed (DBR) breast reconstruction with placement of a PI associated with porcine ADM. The primary endpoint was the postoperative removal of the PI. RESULTS In all, 84 reconstructions were performed. The mean age of the population was 57.5 years. 25.9% of the patients were active smokers at the time of surgery. 89.5% of patients had previously benefited from ipsilateral breast radiation therapy (IBRT) in DBR, 10.5% in IBR. The PI deposition rate, all BR combined, was 21.4%. It was 52.17% in smokers and 9.84% in non-smokers (P<0.0001), making smoking an independent risk factor for reconstruction failure (hazard ratio (HR)=7.4, 95%CI [2.64-20.9]). IBRT was also a risk factor for PI removal, especially when performed after IBR (HR=8.1, 95%CI [1.1-62.1]). CONCLUSION Smoking and adjuvant IBRT are risk factors for failure of reconstruction by PI associated with ADM. This type of reconstruction should be selected for non-smokers who have not undergone IBRT and therefore could be a therapeutic alternative in the BR panel.
Collapse
Affiliation(s)
- L Pouzet
- Plastic, reconstructive and aesthetic surgery department, hôpital Maison Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France.
| | - J Hotton
- Department of surgical oncology, Institut Godinot, 1, rue du Général-Kœnig, 51100 Reims, France
| | - C François
- Plastic, reconstructive and aesthetic surgery department, hôpital Maison Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France; EA 3801, university of Reims - Champagne Ardenne, SFR CAP Santé Reims - Amiens, 51092 Reims, France
| | - K Wehbe
- Department of surgical oncology, Institut Godinot, 1, rue du Général-Kœnig, 51100 Reims, France
| | - C Dabiri
- Department of surgical oncology, Institut Godinot, 1, rue du Général-Kœnig, 51100 Reims, France
| | - V Ceccato
- Department of surgical oncology, Institut Godinot, 1, rue du Général-Kœnig, 51100 Reims, France
| |
Collapse
|
5
|
Kalstrup J, Balslev Willert C, Brinch-Møller Weitemeyer M, Hougaard Chakera A, Hölmich LR. Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety. Breast 2021; 60:192-198. [PMID: 34688959 PMCID: PMC8551207 DOI: 10.1016/j.breast.2021.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Immediate direct-to-implant breast reconstruction with acellular dermal matrix (ADM) is the method of choice for many plastic surgeons and patients, but the use of ADM remains a controversial subject in the literature. This study aimed to investigate complications, reconstructive failure and possible risk factors in direct-to-implant breast reconstruction with ADM (primarily Strattice™). METHODS We retrospectively examined all patients undergoing immediate direct-to-implant breast reconstruction with ADM, during a five-year period (2014-2019) at a university clinic. Study outcomes were all complications and explantations. Complications were stratified within and after 6 months postoperatively and subcategorized by type of intervention. Explantations were subcategorized into loss of implant or salvage with immediate insertion of a tissue expander, the same or a new implant. RESULTS We included 154 patients and 232 breasts. Complications within 6 months per patient included hematoma (4%), seroma (8%), infection (9%), necrosis, wound dehiscence and delayed wound healing (19%). The total complication rate per patient was 34%. Explantation occurred in 20 patients (13%) of which 9 (6% of all) had implant loss. Preoperative radiotherapy was a significant predictor of explantation (adjusted OR 4.9, 95% confidence interval (CI), 1.0-23.5; p = 0.045), and smoking was also associated with risk of explantation, although only borderline significant (adjusted OR 4.0, 95% CI, 1.0-15.8; p = 0.050). CONCLUSION This study demonstrates acceptable rates of re-operations and implant loss compared to other studies but highlights the importance of proper patient selection with regards to risk factors to minimize complications.
Collapse
Affiliation(s)
- Julie Kalstrup
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Cecilie Balslev Willert
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Marie Brinch-Møller Weitemeyer
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Annette Hougaard Chakera
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Lisbet Rosenkrantz Hölmich
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
| |
Collapse
|
6
|
Wang S, He S, Zhang X, Sun J, Huang Q, Liu J, Han C, Yin Z, Ding B, Yin J. Acellular bovine pericardium matrix in immediate breast reconstruction compared with conventional implant-based breast reconstruction. JPRAS Open 2021; 29:1-9. [PMID: 33937472 PMCID: PMC8079238 DOI: 10.1016/j.jpra.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 03/09/2021] [Indexed: 11/26/2022] Open
Abstract
Background Acellular Bovine Pericardium Matrix (ABPM) is a new material in implant-based breast reconstruction (IBBR). Few studies have reported on its outcome and complications worldwide and most studies were without a control group. Our aim was to compare its use in IBBR with the other two conventional implant-based reconstruction methods. Methods A retrospective review of patients undergoing IBBR from January to December 2018 was performed. Patients were assigned to the ABPM-assisted IBBR (group A), latissimus dorsi-assisted IBBR (group B) and two-stage IBBR (group C). Patients’ post-operative complications, cost-effectiveness and Quality of Life were compared. Results 100 patients with 100 breasts were included in the study. No complications occurred in group C (n = 11). No significant differences were noted between group A (n = 44) and group B (n = 45) in terms of overall complications (9.1% vs 11.1%, p = 0.973). Group B had the longest operative duration (310.8 ± 62.3 min, p<0.001). The cost of hospitalization forthe three groups was $8051.3 ± 849.2, $7566.0 ± 1172.7 and $7896.5 ± 1762.2, respectively (p = 0.128). The postoperative Breast-Q scores were similar across the three groups. Conclusions ABPM demonstrated acceptable complication rates, cost-effectiveness and quality of life outcomes when compared to LD-assisted IBBR and two-stage IBBR.
Collapse
Affiliation(s)
- S Wang
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - S He
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - X Zhang
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - J Sun
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Q Huang
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - J Liu
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - C Han
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Z Yin
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - B Ding
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - J Yin
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| |
Collapse
|
7
|
Fakim B, Highton L, Gandhi A, Johnson R, Murphy J. Implant-based breast reconstruction with Artia™ tissue matrix. J Plast Reconstr Aesthet Surg 2019; 72:1548-1554. [PMID: 31201107 DOI: 10.1016/j.bjps.2019.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND In 2015, Artia™ (LifeCell, NJ), a new porcine acellular dermal matrix (ADM), was introduced at our unit. As there is lack of clinical studies on its use in breast reconstruction, the purpose of this prospective study was to assess outcome data for patients who underwent Artia™-assisted breast reconstruction. We compared these data with those of other studies of non-human ADMs in widespread use from the literature. METHODS All consecutive patients who underwent Artia™-assisted breast reconstruction between July 2016 and February 2018 were identified. A prospective database was maintained, including data of patient demographics, type of reconstruction, type of implant, oncological data if applicable, complication rates and adjuvant treatment delays. RESULTS Fifty-one patients undergoing 83 implant-based breast reconstructions with Artia™ were included in the study. Of the 83 reconstructions, 62% were performed following risk-reducing mastectomy, 28% following therapeutic mastectomy and 10% for revision procedures. After a mean 276-day follow-up period, the overall complication rate was 10.8%, including 6 breasts (7.2%) developing seromas requiring aspiration, 1 breast developing a haematoma (1.2%) and 2 implant losses (2.4%) in a single patient following neo-adjuvant chemotherapy. There were no cases of wound dehiscence or erythema/red breast syndrome. CONCLUSION This is one of the first studies demonstrating that Artia™-assisted implant-based breast reconstruction is associated with low and acceptable early complication rates. The results are promising and are comparable to our experience using established ADMs, with an implant loss rate of 4.9% across 500 ADM-assisted implant reconstructions.
Collapse
Affiliation(s)
- Bilal Fakim
- The Nightingale Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Lyndsey Highton
- The Nightingale Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ashu Gandhi
- The Nightingale Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Johnson
- The Nightingale Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - John Murphy
- The Nightingale Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
8
|
The Comparison of Strattice and SurgiMend in Acellular Dermal Matrix-Assisted, Implant-Based Immediate Breast Reconstruction. Plast Reconstr Surg 2019; 142:789e-790e. [PMID: 30222675 DOI: 10.1097/prs.0000000000004895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Holm J, Stolle LB. Non-integrated acellular dermal matrix in breast reconstruction: a case report. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2018; 5:31-34. [PMID: 29713656 PMCID: PMC5918384 DOI: 10.1080/23320885.2018.1456342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/19/2018] [Indexed: 11/23/2022]
Abstract
Acellular Dermal Matrices have become increasing popular in breast reconstruction especially in the last decade. There is a debate on whether Acellular Dermal Matrices increase the risk of complications or not. Common complications include infection, wound dehiscence, necrosis, seroma, haematoma, capsular contracture, extrusion, loss of implant and reconstruction failure. Non-integration is not listed as a typical complication to the use of Acellular Dermal Matrices. We report a case of a completely non-integrated Acellular Dermal Matrix following breast reconstruction in a patient without significant risk factors.
Collapse
Affiliation(s)
- Jens Holm
- Department of Plastic Surgery, Vejle Hospital, Odense, Denmark
| | - Lars B Stolle
- Department of Plastic Surgery, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
10
|
Carbine NE, Lostumbo L, Wallace J, Ko H. Risk-reducing mastectomy for the prevention of primary breast cancer. Cochrane Database Syst Rev 2018; 4:CD002748. [PMID: 29620792 PMCID: PMC6494635 DOI: 10.1002/14651858.cd002748.pub4] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Recent progress in understanding the genetic basis of breast cancer and widely publicized reports of celebrities undergoing risk-reducing mastectomy (RRM) have increased interest in RRM as a method of preventing breast cancer. This is an update of a Cochrane Review first published in 2004 and previously updated in 2006 and 2010. OBJECTIVES (i) To determine whether risk-reducing mastectomy reduces death rates from any cause in women who have never had breast cancer and in women who have a history of breast cancer in one breast, and (ii) to examine the effect of risk-reducing mastectomy on other endpoints, including breast cancer incidence, breast cancer mortality, disease-free survival, physical morbidity, and psychosocial outcomes. SEARCH METHODS For this Review update, we searched Cochrane Breast Cancer's Specialized Register, MEDLINE, Embase and the WHO International Clinical Trials Registry Platform (ICTRP) on 9 July 2016. We included studies in English. SELECTION CRITERIA Participants included women at risk for breast cancer in at least one breast. Interventions included all types of mastectomy performed for the purpose of preventing breast cancer. DATA COLLECTION AND ANALYSIS At least two review authors independently abstracted data from each report. We summarized data descriptively; quantitative meta-analysis was not feasible due to heterogeneity of study designs and insufficient reporting. We analyzed data separately for bilateral risk-reducing mastectomy (BRRM) and contralateral risk-reducing mastectomy (CRRM). Four review authors assessed the methodological quality to determine whether or not the methods used sufficiently minimized selection bias, performance bias, detection bias, and attrition bias. MAIN RESULTS All 61 included studies were observational studies with some methodological limitations; randomized trials were absent. The studies presented data on 15,077 women with a wide range of risk factors for breast cancer, who underwent RRM.Twenty-one BRRM studies looking at the incidence of breast cancer or disease-specific mortality, or both, reported reductions after BRRM, particularly for those women with BRCA1/2 mutations. Twenty-six CRRM studies consistently reported reductions in incidence of contralateral breast cancer but were inconsistent about improvements in disease-specific survival. Seven studies attempted to control for multiple differences between intervention groups and showed no overall survival advantage for CRRM. Another study showed significantly improved survival following CRRM, but after adjusting for bilateral risk-reducing salpingo-oophorectomy (BRRSO), the CRRM effect on all-cause mortality was no longer significant.Twenty studies assessed psychosocial measures; most reported high levels of satisfaction with the decision to have RRM but greater variation in satisfaction with cosmetic results. Worry over breast cancer was significantly reduced after BRRM when compared both to baseline worry levels and to the groups who opted for surveillance rather than BRRM, but there was diminished satisfaction with body image and sexual feelings.Seventeen case series reporting on adverse events from RRM with or without reconstruction reported rates of unanticipated reoperations from 4% in those without reconstruction to 64% in participants with reconstruction.In women who have had cancer in one breast, removing the other breast may reduce the incidence of cancer in that other breast, but there is insufficient evidence that this improves survival because of the continuing risk of recurrence or metastases from the original cancer. Additionally, thought should be given to other options to reduce breast cancer risk, such as BRRSO and chemoprevention, when considering RRM. AUTHORS' CONCLUSIONS While published observational studies demonstrated that BRRM was effective in reducing both the incidence of, and death from, breast cancer, more rigorous prospective studies are suggested. BRRM should be considered only among those at high risk of disease, for example, BRCA1/2 carriers. CRRM was shown to reduce the incidence of contralateral breast cancer, but there is insufficient evidence that CRRM improves survival, and studies that control for multiple confounding variables are recommended. It is possible that selection bias in terms of healthier, younger women being recommended for or choosing CRRM produces better overall survival numbers for CRRM. Given the number of women who may be over-treated with BRRM/CRRM, it is critical that women and clinicians understand the true risk for each individual woman before considering surgery. Additionally, thought should be given to other options to reduce breast cancer risk, such as BRRSO and chemoprevention when considering RRM.
Collapse
Affiliation(s)
- Nora E Carbine
- Georgetown University Lombardi Cancer CenterTranslational Breast Cancer Research Consortium (TBCRC)WashingtonD.C.USA20007
| | | | | | - Henry Ko
- University of SydneyNHMRC Clinical Trials CentreK25 ‐ Medical Foundation Building92‐94 Parramatta Rd.,CamperdownNSWAustralia2050
- Academic Medicine Research Institute, Duke‐NUS Graduate Medical SchoolCentre for Health Services Research, SingHealthSingaporeSingapore169857
| | | |
Collapse
|
11
|
Comparing the Outcome of Different Biologically Derived Acellular Dermal Matrices in Implant-based Immediate Breast Reconstruction: A Meta-analysis of the Literatures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1701. [PMID: 29707460 PMCID: PMC5908498 DOI: 10.1097/gox.0000000000001701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/19/2018] [Indexed: 11/29/2022]
Abstract
Background: Acellular dermal matrices (ADMs) have been used extensively in implant-based breast reconstruction. It was reported that due to the different sources and processing methods, the outcomes of ADMs in implant-based breast reconstructions are expected to differ. We designed this study to statistically analyze and discuss the outcome of 3 commonly used ADMs, Alloderm, Strattice, and Surgimend in implant-based breast reconstruction. Methods: Comprehensive review of the literatures searched on electronic databases was done to identify studies published between 2006 and 2017 comparing the outcome of ADMs. Pooled random effect estimates for each complication and 95% confidence interval (CI) were calculated. One-way analysis of variance and Bonferroni test were used to compare statistical significance between and within groups, respectively. Multiple linear regression was done to include confounding factors and R statistic program for forest plot. Results: Twenty-one studies met the inclusion with a total of 1,659, 999, and 912 breasts reconstructions in Alloderm, Strattice, and Surgimend, respectively. Seven complications extracted including major and minor infection, seroma, implant loss, hematoma, capsular contracture, and localized erythema. Pooled total complication rates were 23.82% (95% CI, 21.18–26.47%) in Strattice, 17.98% (95% CI, 15.49–20.47%) in Surgimend, 16.21% (95% CI, 14.44–17.99%) in Alloderm. Seroma rate was the highest in Strattice group (8.61%; 95% CI, 6.87–10.35%). There was no statistical significance between and within groups. Conclusion: Although Strattice exhibited a higher overall pooled complication rate compared with Alloderm and Surgimend, the incidence of individual complication varies between studies. A cost analysis of different ADMs may aid in choosing the type of ADMs to be used.
Collapse
|
12
|
Karsten MM, Enders S, Knabl J, Kirn V, Düwell P, Rack B, Blohmer JU, Mayr D, Dian D. Biologic meshes and synthetic meshes in cancer patients: a double-edged sword: differences in production of IL-6 and IL-12 caused by acellular dermal matrices in human immune cells. Arch Gynecol Obstet 2018; 297:1265-1270. [PMID: 29417284 DOI: 10.1007/s00404-018-4710-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/01/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE In 2005, Breuing et al. first described the use of acellular dermal matrices (ADMs) in breast cancer patients. ADMs are assumed to be safe to use in an oncologic setting, but data from controlled studies are still needed. Here, we investigate the effects of ADMs on the production of interleukin (IL)-6 and IL-12, key regulators of immune suppression and activation. METHODS Strattice (ST), CollaMend (CM), and Biodesign (BD) biologic meshes and TiLoop, a synthetic mesh (TL), were used in this study. We isolated myeloid dendritic cells (MDCs), untouched plasmacytoid dendritic cells (pDCs), naïve B cells, and CD8+ T cells and co-cultured these cells with either the biologic meshes or TL. As positive controls, we used CpG ODN 2216 or lipopolysaccharide (LPS). The cytokine concentrations of IL-12p70 and IL-6 were determined after 7 days using sandwich ELISA sets. RESULTS There were highly significant differences between the ADMs and TL in terms of their ability to stimulate immunologic responses. IL-6 expression was significantly increased in B cells (p = 0.0006131) and T cells (p = 0.00418) when comparing TL and ADMs. We also identified significant differences in IL-12 production by B cells (p = 0.0166) and T cells (p = 0.003636) when comparing TL and ADMs. CONCLUSIONS Despite the assumed lack of an immunological response to ADMs, in our experimental study, human immune cells reacted with significantly different cytokine profiles. These findings may have implications for the potential activation or suppression of effector cells in cancer patients and could explain some of the post clinical post surgical signs of ADMS like skin rush and seroma.
Collapse
Affiliation(s)
- Maria Margarete Karsten
- Klinik für Gynäkologie und Brustzentrum, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | - Sabine Enders
- Klinik für Frauenheilkunde, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julia Knabl
- Klinik für Frauenheilkunde, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Verena Kirn
- Klinik und Poliklinik für Frauenheilkunde, Universität Köln, Cologne, Germany
| | - Peter Düwell
- Abteilung für klinische Pharmakologie, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Brigitte Rack
- Klinik für Frauenheilkunde, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie und Brustzentrum, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Doris Mayr
- Abteilung für Pathologie, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Darius Dian
- Klinik für Frauenheilkunde, Ludwig-Maximilians-Universität München, Munich, Germany
| |
Collapse
|
13
|
The Comparison of Strattice and SurgiMend in Acellular Dermal Matrix–Assisted, Implant-Based Immediate Breast Reconstruction. Plast Reconstr Surg 2018; 141:283-293. [DOI: 10.1097/prs.0000000000004018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Bovine Acellular Dermal Matrix in Immediate Breast Reconstruction: A Retrospective, Observational Study with SurgiMend. Plast Reconstr Surg 2018; 141:1e-10e. [PMID: 29280856 DOI: 10.1097/prs.0000000000003982] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acellular dermal matrices can be combined with implant-based breast reconstruction to help optimize outcomes. SurgiMend PRS is a fetal bovine dermis-derived acellular dermal matrix composed of type I collagen and approximately 30 percent type III collagen, sharing many of the properties of human cadaveric acellular dermal matrix. METHODS This was a retrospective, single-center analysis of 111 adult patients (147 breasts) undergoing one-stage (83.7 percent) or two-stage (16.3 percent) immediate breast reconstruction after mastectomy. The aims were to characterize the safety profile of SurgiMend and investigate associations between risk factors and complications. RESULTS The mean age of the patients was 47.9 years and the mean body mass index was 24.7 kg/m. After a median follow-up of 24.3 months, the overall rates of minor and major complications were 25.2 percent (n = 37 of 147) and 12.9 percent (n = 19 of 147), respectively. The most common major complications were seroma [n = 12 (8.2 percent)] and necrosis [n = 9 (6.1 percent)]. All occurred within 3 months after surgery. The rate of capsular contracture was 2.7 percent (n = 4). A total of 2.7 percent of implanted breasts (n = 4) required explantation. In a univariate analysis, smokers had a greater risk of major complications (p = 0.013), and postoperative radiation therapy and obesity were associated with an increased risk of capsular contracture (p = 0.006) and explantation (p = 0.006), respectively. In a multivariate analysis, several factors were associated with complications or explantation, including obesity (p < 0.05), preoperative chemotherapy (p < 0.001), and mastectomy weight (p < 0.05). These associations align with other studies of implant-based reconstruction and do not appear to be specific to this acellular dermal matrix. CONCLUSION The results are consistent with previous analyses of SurgiMend, and support its value in implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
|
15
|
Mazari FAK, Asgeirsson KS, Whisker L, Gutteridge E, Rasheed T, Douglas Macmillan R. Complete resorption of Veritas® in acellular dermal matrix (ADM)-assisted implant-based breast reconstructions—is there a need for tighter regulation of new products developed for use in breast reconstruction? EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-017-1389-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
16
|
Hallberg H, Rafnsdottir S, Selvaggi G, Strandell A, Samuelsson O, Stadig I, Svanberg T, Hansson E, Lewin R. Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis. J Plast Surg Hand Surg 2018; 52:130-147. [PMID: 29320921 DOI: 10.1080/2000656x.2017.1419141] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In modern implant-based immediate breast reconstruction, it has become common to use biological acellular dermal and synthetic matrices in combination with a tissue expander or an implant. The aim of this systematic review was to examine differences in recurrence of cancer, impact on oncological treatment, health related quality of life, complications and aesthetic outcome between matrix and no matrix in immediate breast reconstruction. Systematic searches, data extraction and assessment of methodological quality were performed according to predetermined criteria. Fifty-one studies were eligible and included in the review. The certainty of evidence for overall complication rate and implant loss is low (GRADE ⊕⊕□ □). The certainty of evidence for delay of adjuvant treatment, implant loss, infection, capsular contraction and aesthetic outcome is very low (GRADE ⊕□ □ □). No study reported data on recurrence of cancer or health related quality of life. In conclusion, there is a lack of high quality studies that compare the use of matrix with no matrix in immediate breast reconstruction. Specifically, there are no data on risk of recurrence of cancer, delay of adjuvant treatment and Health related quality of life (HRQoL). In addition, there is a risk of bias in many studies. It is often unclear what complications have been included and how they have been diagnosed, and how and when capsular contracture and aesthetic outcome have been evaluated. Controlled trials that further analyse the impact of radiotherapy, type of matrix and type of procedure (one or two stages) are necessary.
Collapse
Affiliation(s)
- Håkan Hallberg
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Svanheidur Rafnsdottir
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,c Department of Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Gennaro Selvaggi
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Annika Strandell
- d Health Technology Assessment centre , Region Västra Götaland , Gothenburg , Sweden
| | - Ola Samuelsson
- d Health Technology Assessment centre , Region Västra Götaland , Gothenburg , Sweden
| | - Ida Stadig
- e Medical Library , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Therese Svanberg
- d Health Technology Assessment centre , Region Västra Götaland , Gothenburg , Sweden
| | - Emma Hansson
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Richard Lewin
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| |
Collapse
|
17
|
What’s New in Acellular Dermal Matrix and Soft-Tissue Support for Prosthetic Breast Reconstruction. Plast Reconstr Surg 2017; 140:30S-43S. [DOI: 10.1097/prs.0000000000003950] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
18
|
A Limited Submuscular Direct-to-Implant Technique Utilizing AlloMax. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1408. [PMID: 28831349 PMCID: PMC5548572 DOI: 10.1097/gox.0000000000001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/19/2017] [Indexed: 11/30/2022]
Abstract
This study evaluates a novel limited submuscular direct-to-implant technique utilizing AlloMax where only the upper few centimeters of the implant is covered by the pectoralis, whereas the majority of the implant including the middle and lower poles are covered by acellular dermal matrix.
Collapse
|
19
|
A direct comparison of porcine (Strattice™) and bovine (Surgimend™) acellular dermal matrices in implant-based immediate breast reconstruction. J Plast Reconstr Aesthet Surg 2017. [DOI: 10.1016/j.bjps.2017.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
20
|
Onesti MG, Maruccia M, Di Taranto G, Albano A, Soda G, Ballesio L, Scuderi N. Clinical, histological, and ultrasound follow-up of breast reconstruction with one-stage muscle-sparing "wrap" technique: A single-center experience. J Plast Reconstr Aesthet Surg 2017; 70:1527-1536. [PMID: 28736191 DOI: 10.1016/j.bjps.2017.06.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 05/02/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prepectoral implant placement and complete coverage with porcine acellular matrix after mastectomy is a new concept in breast surgery presented in few cases in the literature. This paper aimed to present our single-center experience in one-stage breast reconstruction muscle-sparing "wrap" technique by evaluating clinical and aesthetic outcomes, ultrasound and histological examination, and patient quality of life. METHODS From January 2014 to January 2017, 52 patients (40 unilateral, 12 bilateral) underwent one-stage muscle-sparing breast reconstructions with Braxon® acellular dermal matrix and implant. In 3 patients, a surgical biopsy and histological examination with immunohistochemical analysis of the periprosthetic tissue were performed. All patients underwent breast ultrasound examination, and the occurrence of capsular contracture was assessed through the Baker classification and by measuring the mammary compliance scores with the Antoon Paar Mammary compliance system. Breast appearance was evaluated using a visual analogue scale (VAS) and in terms of quality of life using the EOCRT QLQ C-30 and QLQ BR-23 questionnaires. RESULTS Early and late postoperative complications are reported. Histological and ultrasound evaluation showed a complete integration of the matrix. According to the VAS scale, the EOCRT QLQ C-30, and QLQ BR-23, patients' satisfaction resulted in a high score in terms of quality of life and aesthetic outcomes. CONCLUSION The results of this new surgical technique in selected cases are promising in terms of effectiveness and low rate of postoperative complications, but further long-terms evaluations are required.
Collapse
Affiliation(s)
- Maria Giuseppina Onesti
- Department Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy
| | - Michele Maruccia
- Department Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy.
| | - Giuseppe Di Taranto
- Department Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy
| | - Antonio Albano
- Department Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy
| | - Giuseppe Soda
- Department of Molecular medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Ballesio
- Department of Radiological, Oncological, Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicolò Scuderi
- Department Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy
| |
Collapse
|
21
|
Helling AL, Tsekoura EK, Biggs M, Bayon Y, Pandit A, Zeugolis DI. In Vitro Enzymatic Degradation of Tissue Grafts and Collagen Biomaterials by Matrix Metalloproteinases: Improving the Collagenase Assay. ACS Biomater Sci Eng 2016; 3:1922-1932. [PMID: 33440550 DOI: 10.1021/acsbiomaterials.5b00563] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Matrix metalloproteinase-1 and -8 are active during the wound healing and remodelling processes, degrading native extracellular matrix and implantable devices. However, traditional in vitro assays utilize primarily matrix metalloproteinase-1 to mimic the in vivo degradation microenvironment. Herein, we assessed the influence of various concentrations of matrix metalloproteinase- 1 and 8 (50, 100, and 200 U/mL) as a function of pH (5.5 and 7.4) and time (3, 6, 9, 12, and 24 h) on the degradation profile of three tissue grafts (chemically cross-linked Permacol, nonchemically cross-linked Permacol and nonchemically cross-linked Strattice) and a collagen biomaterial (nonchemically cross-linked collagen sponge). Chemically cross-linked and nonchemically cross-linked Permacol samples exhibited the highest resistance to enzymatic degradation, while nonchemically cross-linked collagen sponges exhibited the least resistance to enzymatic degradation. Qualitative and quantitative degradation analysis of all samples revealed a similar degradation profile over time, independently of the matrix metalloproteinase used and its respective concentration and pH. These data indicate that matrix metalloproteinase-1 and matrix metalloproteinase-8 exhibit similar degradation profile in vitro, suggesting that matrix metalloproteinase-8 should be used for collagenase assay.
Collapse
Affiliation(s)
| | | | | | - Y Bayon
- Sofradim Production, A Medtronic Company, Trévoux, France
| | | | | |
Collapse
|